But in testimony to be delivered to a House budget committee Wednesday, association lobbyist Tim Maglione’s says: “As advocates for patients and for the opportunities to create a healthier Ohio, the Ohio State Medical Association believes that this expansion makes sense.”

The association is among many expansion advocates, joining Gov. John Kasich in embracing one part of a law they otherwise find distasteful. The argument seems to boil down to: If you can’t beat ’em, accept the billions of dollars they’re sending your way.

Kasich’s biennial budget says Ohio would save millions of dollars in the next two years if it lowers the income threshold for Medicaid eligibility because the federal government would pick up the entire $2.4 billion cost of new enrollees and other factors reduce Ohio’s costs.

“When the (Affordable Care Act) was going through Congress, we were opposed to it for a lot of reasons,” Maglione told me. “Now that it’s the law of the land, and the Supreme Court upheld it, and the states have the option to expand Medicaid, the option of expanding is better than doing nothing at all.”

His testimony would echo the reasons Central Ohio hospital CEOs support the expansion – even if some of them as individuals don’t like the law. Doctors and hospital administrators argue that enrolling low-income adults in Medicaid and getting them better primary care would prevent emergency room visits and hospitalizations, reducing overall health spending.

Maglione’s testimony further suggests changes to Medicaid that the association says would help with accommodating the expansion, including higher reimbursement rates for doctors, a greater call for personal responsibility for wellness from Medicaid enrollees and a simpler administrative structure.

Still, many Ohio Republican legislators remain opposed to expanding Medicaid, even if Ohio comes out ahead, because of concerns over the federal debt.

Maglione told me he has a lot of “education” tasks ahead of him.

“A lot of the concerns we’re hearing are really more philosophical,” he said. “It’s an opportunity to create a healthier Ohio.”